Individual
WALTER FASKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 BUCKLIN ST STE 1, LA SALLE, IL 61301-2382
(815) 780-0690
Mailing address
7648 S OCONTO AVE, BRIDGEVIEW, IL 60455-1323
(708) 979-1815
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
36350
IL
Other
Enumeration date
09/16/2022
Last updated
11/04/2022
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